Insurances

The insurance category of the Properties tab is where insurance companies for billing purposes will be entered. Insurance companies must be entered before insurances can be set on the patient's chart, billed to, or payments can be downloaded.

Insurance information will be provided by your clearing house and can be found on the Clearinghouses website.

Adding Insurance Records

To add insurance companies to your database, you will use the Insurance menu. You can add a new insurance by clicking the green “Add” button in the upper left-hand portion of the screen from the Insurance category of the properties tab. Newly created insurances will automatically be set to receive ICD-10 codes as the preferred coding format.

Insurance companies have a a wide variety of information and settings available on each record.

Insurance Company Editor Window

The insurance company editor window is broken down into several tabs along the top of the screen. These tabs are:

General

This tab contains general identification information for this insurance company.

Name — The name of the insurance company.

Address Line 1, Address Line 2 — Address information for the insurance company.

Phone (Secondary) — Secondary contact number for this insurance company.

E-Mail — Primary email contact for that insurance company.

Website — The insurance companies website.

Contacts — List of contacts at that insurance company.

Payer ID — The identification number for the insurance company. Can be found on the payer list. This is the number TRAKnet will use for insurance identification.

Claim Office Number — Claim office identification number.

Clearinghouse — The clearinghouse to be used when sending claims and eligibility requests for this insurance.

Claim Details

The claim details tab of the Modify Insurance window contains various insurance specific settings for billing purposes. These settings will determine how the claim will send to fit a specific insurance's preferences. The settings are detailed below.

Practice Legacy Number — A specific identifier that may have been assigned by this insurance company for this practice. These numbers are not required in all situations as they have been slowly phased out and replaced by NPI.

Has Assignment — A true or false setting. Can this insurance company assign benefits to the practice on behalf of the patient? If true, then the practice is authorized to receive payments directly on submitted charges. If false, patients will receive insurance payments.

Request Eligibility — A true or false setting. Can eligibility requests be sent? If True, then eligibility requests can be submitted to this insurance company. Some insurances require enrollment and charge per request.

Minnesota Care Tax Eligible — A true or false setting. Is the practice response to Minnesota Care Tax when accepting payments from this insurance? If true, then the practice will need to account for this tax on any payment received from this insurance.

Print Address — A true or false setting. If true, then insurance address will print in the upper right-hand corner of the CMS. If false, then the upper right-hand corner will be blank.

Set Box 9a from Box 1a — A true or false setting. If true, then Box 9a will always use the information as entered in Box 1a. If false, then Box 9a will use the information as it pertains to the other insurance.

Box 17a Identifier — A setting to determine which referring provider identification number will be printed on the CMS claim, when available. Can be: UPIN, Legacy Number, SSN, Taxonomy Code or none.

Use box 17a Qualifier — A true or false setting. If true, then the CMS two character qualifier for the respective identifier (UPIN, legacy number, SSN, Taxonomy Code) will print.

Send NDC in Box 24f — A true or false setting. If true and the treatment has an associated NDC, it will print in box 24f above the charge amount.

Box 24j Qualifier — A true or false setting. If true, then the CMS two character qualifier for the respective identifier (UPIN, Legacy Number, SSN, Taxonomy Code) will print.

Box 29 Amount (Primary) — The amount to be calculated in Box 29 based upon a primary claim submission. If none, then the field will be blank. If all, then adjustments/WO will be included in the calculation.

Box 29 Amount (Other) — The amount to be calculated for Box 29 based upon a secondary, tertiary or other claim submission. If none, then the field will be blank. If all, the adjustments/WO will be included in the calculation.

Box 30 Amount (Primary) — The amount to be displayed for Box 30 based upon a primary claim submission. If none, then the field will be blank. This is no longer a required box on the CMS 02/12 claim form.

Box 30 Amount (Other) — The amount to be displayed for Box 30 upon a secondary, tertiary or other claim submission. If none, then the field will be blank.

Use Box 32 — A true or false setting. Print location, NPI, and legacy numbers in Box 32 on the CMS 1500 form when the place of service is 12 (patient's home)? If false, then the service facility location, NPI and legacy number will not print when the place of service is 12.

Set Admit Dx (Box 69) from Principal Dx (Box 67) — A true or false setting. Set Admit Diagnosis (Box 69) as the same as Principal Diagnosis (Box 67).

Set Referring Provider to Other Provider (Box 78 or Box 79) — Sets the referring provider to either Box 78 or Box 79.

Claim Offices

Claim offices are insurance companies that are the same Payer ID as the "parent" or main insurance but have a different address. Claim offices are key to keeping billing in TRAKnet organized. The rule of thumb is as follows:

Does the new Insurance company have the same payer ID as an existing Insurance company?

If yes, then create as a claim office of the existing Insurance company. Modify the existing insurance, click on Claim Offices, and click Add.

If no, then create as its own insurance company.

If the insurance company that should become a claim office is already an existing insurance company, modify the existing insurance, and click Convert to Claim Office. Select the insurance company it is going to become a claim office of, and confirm. This is permanent.

Legacy Numbers

A location to set additional legacy numbers as required on a per insurance basis.

Treatments

A location to set which Treatments will be sent with a description when the ANSI 837 setting Send Treatment Description is set to True.

Adjustment Codes

A location to set which Adjustment Codes will be automatically applied to remittances downloaded from a clearing house.

Fee Scheduler

A location to set the Fee scheduler for Treatments for this insurance.

Comments

A free type area where additional comments about the insurance company can be recorded.

Finalizing an Insurance Company

Once you have finished adding information to the Insurance editor window, click “Save” in the upper-right hand corner of this screen.